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Cancer Pain Management Guidelines Issued

Chronic pain is a fact of life for as many as 85 million Americans yet it remains sorely undertreated, especially among cancer patients, one-third of whom do not get the relief they need.

Studies show nearly 90% of all cancer pain can be successfully managed, but too often patients do not get the painkillers they need. Some mistakenly believe they are supposed to suffer in silence, and many doctors fear losing their licenses if they prescribe too much medication.

There is even a black market for painkillers, according to this week's Newsweek, and some pharmacies even refuse to stock drugs like Oxycontin, fearing theft.

But as Paul Moniz reports, in an attempt to deliver better care, the influential National Comprehensive Cancer Network has issued cancer patients the pain measurement and management guidelines that their doctors have had for years in a reader-friendly format. Patients can learn how to rate their pain on a zero-to-ten scale and discuss commonly used painkillers.

The pain management guidelines can be found at www.nccn.org and on the American Cancer Societys web site www.acs.org.

Graceanne Koslak, at just 54, has had a hysterectomy, a breast removed, and a portion of her lung taken out. Chemotherapy caused a stroke. The four separate cancers beginning in her 20s caused unbearable pain that for years went untreated.

"They say rate the pain on a scale of 1 to 10. Mine was probably a 12," she estimates.

Like many patients, Graceanne was at first hesitant to take pain medication, fearing addiction. But now she says the medications have lifted her depression and improved her quality of life.

"I can't describe it," she says. "It has meant everything. I couldn't do anything for awhile."

Advocates say the risks of addiction are largely exaggerated. They also hope the guide prompts cancer patients and their families to have a more open dialogue with doctors.

"A daughter . . . needs to say to the oncologist, 'Thank-you for explaining what kind of chemotherapy you'll do. Now tell me what you're going to do for my mother's pain," says Betty Ferrell, a nurse at the City of Hope Cancer Center.

Another problem with pain medication is insurance coverage. The pills can cost hundreds of dollars a bottle and some private insurance companies will not pay for them--nor will Medicare.

Advocates say Congress must step in and make coverage of pain management mandatory.